| NPI | 1003894007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60175109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A5460) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2018-12-13 |